Compartment Syndrome: Diagnosis, Management, and Unique Concerns in the Twenty-First Century

Compartment syndrome (CS) occurs when fascial compartment pressures exceed perfusion pressure, leading to irreversible tissue ischemia and necrosis .While literature emphasizes the acute phase, it is important to note that compartment syndrome exists on a spectrum, ranging from acute to chronic. With careful attention to details such as intraoperative positioning, anesthetic choice, and placement of stockings and splints, orthopedic surgeons have the opportunity to modify risk. The sequelae of compartment syndrome have functional, cosmetic, and legal ramifications. Effective treatment begins with early diagnosis.

It is the intent of this article to review common and uncommon causes of compartment syndrome, to highlight the difficulties associated with the identification of patients at risk, and to discuss unique problems surrounding the diagnosis and management of compartment syndrome. Further, we present an algorithm designed to provide a standardized method of patient assessment given the increased frequency of patient “handoffs” that has occurred in the past decade as a consequence of resident work hour restrictions and the increased use of midlevel providers.

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